Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Cory Wallace, PHARMD

Individual provider Pharmacist · NPI 1972103745

Cory Wallace, PHARMD is a Pharmacist in Broken Arrow, Oklahoma. Practices as a sole proprietor. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2020
What do these letters mean?
PHARMD — Doctor of Pharmacy
The professional degree required to practise as a pharmacist in the United States.

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Practice location Address checks out

2301 W Kenosha St
Broken Arrow, OK 74012-8912
Phone: (918) 259-9136
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 14955 (OK)

Record details

NPI number1972103745
Entity typeIndividual (Type 1)
GenderMale
Credentials PHARMD
Sole proprietorYes
NPI enumeratedOctober 29, 2020
Last updated in NPPESOctober 29, 2020
Certification dateOctober 29, 2020
Mailing address11005 S Joplin Pl, Tulsa, OK 74137-5023

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